‘Intervene’ now to save mothers and children

A new global consensus has been agreed on the key evidence-based interventions that will sharply reduce the 358,000 women who still die each year during pregnancy and childbirth and the 7.6 million children who die before the age of five, according to an extensive three-year global study.
The study, “Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health” is designed to facilitate decision-making in low- and middle-income countries about how to allocate limited resources for maximum impact on the health of women and children.
The authors, the World Health Organisation (WHO), the Aga Khan University and The Partnership for Maternal, Newborn and Child Health (PMNCH) reviewed more than 50,000 scientific papers to determine the proven effectiveness of interventions and impact on survival, identifying 56 essential interventions that when implemented in “packages” relevant to local settings, are most likely to save lives.
For the suitability for low- and middle-income countries, the first step was a global landscape analysis of what countries and the 440 PMNCH partners were doing to reduce maternal and newborn deaths.
“What came back was a hodge-podge,” says Dr Zulfiqar Bhutta, founding chair of women and child health at the Aga Khan University, who headed the study team. “PMNCH partners had very different ideas of what should be undertaken,” he added
In all, 142 interventions were assessed for their effectiveness and impact on survival by addressing the main causes of maternal, newborn, and child mortality. Dr Bhutta and Dr Elizabeth Mason, director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health and their team also studied the intervention suitability for use in low- and middle-income countries.
After very extensive consultation and review by a wide group of experts, the list was honed down to 56 essential interventions, accompanied by brief guidelines and reference materials.
 Considering the maternal and child deaths still a problem, it was decided that though considerable progress has been made toward reducing maternal, infant and child deaths, Sub-Saharan Africa and south Asia, including Pakistan, will fall short of the United Nation’s Millennium Development Goals Four and Five, which aim to reduce child deaths and improve maternal health by 2015.
More than half of maternal deaths are caused by excessive bleeding (35 percent) and hypertension (18 percent).
 A child’s greatest risk of dying is during the first 28 days of life, accounting for 40 percent of all deaths among children under the age of five. Half of newborn deaths occur during the first 24 hours and 75 percent during the first week of life, with preterm birth, severe infections and asphyxia being the main causes.
The underlying thrust of “Essential Interventions” is to support low- and middle- income countries to meet the Millennium Development Goals Four and Five. It gives policy makers a way to make informed choices on how to set priorities and where to put their funds and resources, guided by a list of absolutely critical interventions.
 The interventions are classified according to three levels including care that can be provided at the community level by community health workers, outreach workers, and volunteers with limited training; primary care, also delivered in the community at a clinic by professionals – nurses, midwives, community health workers – with more training and referral care provided by physicians and skilled nurses and midwives in a hospital able to do caesarean sections and provide emergency care.
 The interventions are also classified according to six target groups including adolescent and pre-pregnancy, pregnancy (before birth), childbirth, postnatal (mother), postnatal (newborn) and infancy and childhood.
 In addition to identifying the interventions, the document provides clear guidance on what is needed in terms of training and equipment. For example, if newborns are not breathing, resuscitation equipment is needed.
  “I am sure that this research will help to reduce deaths among mothers, newborns and children and will help direct funds and resources to concerted action based on the best evidence for impact,” said Dr Bhutta.